Caregiving: Is TB a worry?

ALBANY, N.Y., June 5 (UPI) -- The trouble with being a caregiver -- especially for the elderly, who are frail -- is that we tend to get germ-phobic. We carry bottles of alcohol-based cleaner in all of our pockets and we scurry when someone coughs.

For someone recovering from cancer surgery or with heart failure, even a little cold can lead to a lengthy illness and complications like bronchitis or pneumonia. We become accustomed to "minimizing social contact" to minimize the chance of infection.

The caregiver becomes adept at dealing with the millions of bacteria found on shopping cart handles, but the case of the 31-year-old, apparently healthy Atlanta lawyer who contacted XDR TB, an extremely rare type of tuberculosis, makes the caregiver wonder: What kind of threat does TB pose?

It depends on where you live and with whom you have contact. More than one-third of the global population is infected with TB bacterium and each year, 8 million people become ill with TB and 2 million people die, according to the Centers for Disease Control and Prevention in Atlanta.

In the United States, a total of 14,511 TB cases were reported in 2004, while the overall TB case rate -- 4.9 per 100,000 persons -- was the lowest recorded since reporting began in 1953, the CDC said.

California, Florida, Georgia, Illinois, New Jersey, New York and Texas account for 60 percent of the national TB case total. The TB case rate among Asians was 20 times higher than that among whites, while African-Americans and Hispanics each had rates eight times higher than whites, the CDC said.

"Relative to other countries, the incidence of TB in this country is relatively low -- we have generally good healthcare and good hygiene; however, the case numbers had been in decline until HIV -- TB occurs in situations where people are in close contact with infected individuals and cases are not diagnosed or treated aggressively," Randall Basaraba, of the department of Microbiology, Immunology and Pathology at Colorado State University, told United Press International's Caregiving.

"We may never know when we come in contact with a person infected with TB, but it really does require prolonged close contact and depends on how advanced their disease is."

Only people who are sick with TB in their lungs are infectious -- they cough, sneeze, or talk and propel TB germs, according to the World Health Organization.

Andrew Speaker, the Atlanta attorney who made international headlines for traveling by plane after he knew he had multidrug-resistant TB, said he was not coughing or sneezing when he took several flights from Atlanta to Greece and Italy, and returned via Prague and Canada.

The first two of three planned sputum test results for Speaker have come back negative, and if the third proves negative he would be considered "relatively non-contagious," according to a statement by the National Jewish Hospital in Denver.

The vast majority of people exposed to TB don't come down with an infection -- 90 percent of healthy people can clear TB on their own, according to Basaraba.

Approximately 5 percent to 10 percent of those infected -- but who are not infected with HIV -- become sick or infectious at some time during their life, explains a WHO fact sheet.

The disease develops in the presence of factors that disturb immune function, such as immunosuppression, diabetes, alcoholism, nutritional deficiencies, stress and -- above all -- co-infection with HIV, WHO said.

People can harbor or "wall off" TB, but if the body's immunity suffers, the disease can reappear. In the past people with TB were treated with surgery and isolation in sanatoria to prevent the spread of the disease and to help the patient boost immunity, but in 1946 Rutgers University microbiologist Selman Waksman discovered streptomycin, the first drug to halt TB.

Antibiotics have treated the disease for decades, but since 2000, TB drug resistant strains have emerged as a result of inconsistent or partial use of the antibiotics. Patients start to feel better, forget, or do not have a consistent supply of drugs, especially in poor or remote areas.

"The drug resistance is not because of over-prescribing of broad spectrum antibiotics as is the case with other types of bacteria, since a limited number of antibiotics are effective against TB," Basaraba said.

Multidrug-resistant TB, or MDR TB, is resistant to at least two of the best anti-TB drugs, while extensively drug resistant TB, or XDR TB, is a rare type of MDR TB and resistant to at least one of three injectable second-line medications.

In 2005, there were 124 cases of multi-drug-resistant TB in the United States. Between 1993 and 2006, there were 49 cases of XDR TB, according to the CDC.

Speaker, who has the very rare XDR TB, will be treated with intravenous drugs. If they are not effective, he will undergo surgery. His case was caught early -- before symptoms -- following a chest X-ray taken after rib injury.

"Because of the strain of TB he is infected with, his case could be life-threatening if the infection had not been detected and his treatment aggressive -- but since he is still clinically healthy and the tissue damage was limited by early detection, he has a good prognosis for survival," Basaraba said.

"If the infection was not detected, he could have harbored it for a long time -- decades -- before getting sick."

How Speaker got XDR TB is the $64,000 question. His father-in-law works on TB at the CDC, but it has been reported that the strain he works on is different. More likely, Speaker became infected while on an earlier trip to Asia.

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Alex Cukan is an award-winning journalist, but she has also been a caregiver since she was a teenager. UPI welcomes comments and questions about this column, e-mail: consumerhealth@upi.com.